Why Huge Quality Gaps Among Nursing Homes Are Likely To Grow If Medicaid Is Cut

Nursing homes that rely the most on Medicaid tend to provide the worst care for their residents — not just the people covered by the program but also those who pay privately or have Medicare coverage.

Despite the collapse of the latest Senate effort to repeal the Affordable Care Act, congressional Republicans are still keen on shrinking the amount of Medicaid money Washington sends states.

Down the line, this would create problems for the nation’s 1.4 million nursing home residents — two-thirds of whom are covered by the state-federal health care program for people with low incomes or those with disabilities.

Medicaid already pays less than other forms of insurance. As a result, nursing homes make more than 10 percent on Medicare residents, but lose about 2 percent on the rest of their residents because so many have care paid for by Medicaid.

If the feared reductions in federal funding come to fruition, states would likely respond by either lowering their payment rates or restricting whom they cover and for how long. And the quality of care, experts say, would deteriorate further.

Three charts, based on a Kaiser Health News analysis of ratings from the federal government’s Nursing Home Compare website, illustrate how care suffers in nursing homes where Medicaid is the dominant payer for residents.